AUTHORIZATION AGREEMENT FOR
PREAUTHORIZED PAYMENTS:
Company
name-CYBRTOWN.COM
I (WE) hereby authorize CYBRTOWN, to initiate debit entries to MY(our) checking account indicated below and the depository name below, hereinafter called DEPOSITORY, to debit the same to such account.
BANK
NAME_____________________ BRANCH________________________
CITY____________________________STATE______ZIP___________
ACCOUNT NO.______________________________________________
ROUTING
NO._______________________________________________
This authority is to remain in
full force and effect until CYBRTOWN and DEPOSITORY has received written
notification from me of it's termination in such time and in such manner as to
afford CYBRTOWN and DEPOSITORY a reasonable opportunity to act on it.
NAME(PLEASE
PRINT)__________________________________________
USER NAME____________________________________________________
DATE______________SIGNED X___________________________________
Please print this and send with
voided deposit slip to:
CYBRTOWN.COM